Small transrectal ultrasound volume predicts clinically significant Gleason score upgrading after radical prostatectomy: Results from the SEARCH database

被引：53

作者：

Turley, Ryan S. ^{[1
]}

Hamilton, Robert J. ^{[1
]}

Terris, Martha K. ^{[4
,5
]}

Kane, Christopher J. ^{[6
,7
]}

Aronson, William J. ^{[8
,9
]}

Presti, Joseph C., Jr. ^{[10
,11
]}

Amling, Christopher L. ^{[12
]}

Freedland, Stephen J. ^{[1
,2
,3
]}

机构：

[1] Duke Prostate Ctr, Div Urol Surg, Durham, NC USA

[2] Duke Univ, Sch Med, Dept Pathol, Div Urol, Durham, NC 27710 USA

[3] Vet Affairs Med Ctr, Urol Sect, Durham, NC USA

[4] Vet Affairs Med Ctr, Urol Sect, Augusta, GA USA

[5] Med Coll Georgia, Urol Sect, Augusta, GA 30912 USA

[6] Vet Affairs Med Ctr, Urol Sect, San Francisco, CA 94121 USA

[7] Univ Calif San Francisco, Sch Med, Dept Urol, San Francisco, CA 94143 USA

[8] Vet Affairs Greater Los Angeles Healthcare Syst, Urol Sect, Los Angeles, CA USA

[9] Univ Calif Los Angeles, Dept Urol, Los Angeles, CA USA

[10] Stanford Univ, Sch Med, Dept Urol, Palo Alto, CA 94304 USA

[11] Vet Affairs Med Ctr, Urol Sect, Palo Alto, CA 94304 USA

[12] Univ Alabama, Div Urol, Birmingham, AL USA

来源：

JOURNAL OF UROLOGY | 2008年 / 179卷 / 02期

关键词：

prostate; prostatic neoplasms; biopsy; needle; prostatectomy;

D O I：

10.1016/j.juro.2007.09.078

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Purpose: Needle biopsy Gleason scores are often upgraded after pathological examination of the prostate following radical prostatectomy. It has been suggested that larger prostates would be associated with a greater risk of upgrading since a smaller percentage of the gland is sampled and, thus, the highest grade disease would more likely be missed, assuming an equal number of cores is taken from similar locations. We examined the likelihood of clinically relevant upgrading after radical prostatectomy as a function of transrectal ultrasound volume. Materials and Methods: We examined the association between transrectal ultrasound volume and upgrading (higher Gleason score category in the radical prostatectomy specimen than in the biopsy) in 586 men treated with radical prostatectomy between 1995 and 2006 in the SEARCH database who underwent at least a sextant biopsy using multivariate logistic regression. Transrectal ultrasound volume was categorized as 20 or less (in 71), 21 to 40 (in 334), 41 to 60 (in 123) and greater than 60 cm(3) (in 58). Gleason score was examined as a categorical variable of 2-6, 3 + 4 and 4 + 3 or greater. Results: Overall 138 cases (24%) were upgraded, 80 (14%) were downgraded, and 368 (62%) had identical biopsy and pathological Gleason sum groups. Larger transrectal ultrasound volume was significantly associated with decreased likelihood of upgrading (p trend < 0.001). For transrectal ultrasound volumes greater than 60, 41 to 60, 21 to 40 and 20 cm(3) or less, the estimated multivariate adjusted probability of upgrading was 12.6%, 27.5%, 36.4% and 45.5% for Gleason 2-6 tumors, and 6.1%, 8.5%, 18.9% and 20.9% for Gleason 3 + 4 tumors, respectively. Conclusions: Larger transrectal ultrasound volumes were at decreased risk for clinically significant upgrading after radical prostatectomy. This fact should be kept in mind when deciding on treatment decisions for men with apparently low grade prostate cancer on biopsy.

引用

页码：523 / 527

页数：5

共 17 条

[1] Prostate volume is strongest predictor of cancer diagnosis at transrectal ultrasound-guided prostate biopsy with prostate-specific antigen values between 2.0 and 9.0 ng/ml [J].